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11/20/2017 MON 15: 09 FAx Az'k Kdndgement f�003/OOd
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<br /> „� ,r,"�d�;'�' r'r'a:il, :�, `;+ �,� �.� ;1�' . '•L i,;:,^.',: 'i; .sG:'M'•.,�;, ,
<br /> d.
<br /> FIXTURE BSMT 1s 2 OTN�R FI?(TURE BSMT 1ST 2N0 OTHEF�
<br /> TYPE Floor Floor TYPE Fbvr Floor
<br /> Water Closet FlOor Dralns
<br /> Lavatory Sewer Ejector
<br /> Bathtub Laundry Tray
<br /> Shower Washer
<br /> Kitchen Sink Water Fleater �
<br /> Disposal Water Soitener �
<br /> Dishwesh�r Wet Bar
<br /> Si��cocks Mfscellaneous � '�� ' ,�
<br /> ',51�,� i�A.��'1:�. ,�pF 1'l.0 i�, )r ` '� �'71.• �� /1M�� " ��� ,A11 r'.�,i�„����:;.:,�.n'7 ���i •�\iN "r"y , i;�•.j'
<br /> �.�� �,i r�i;1 K1 G� �"f i ti�r T � i I��S}`t•� �ji•' t' f� ��'Y�" �f
<br /> �, ..,>��` •�, �2 T� + 1� �• :,, 'J,,,,,'. .'y'!. „��' ,
<br /> .•r;
<br /> 1. CONTRACT PRIC� "fs 1.�5�0 of contract price with a(Mlnlmum Fee of i50.00)
<br /> '���V x ,0125 $� �� , • CJ��
<br /> (contract price) (rni�imum$50.00)
<br /> 2. STATE SIJRCHAR(3E
<br /> �1�,,,�,� x .0005 $ �° �`�
<br /> (contract price)
<br /> 3. POSTAGE �HANDLINO(anly on Mail-In Applications) $ 2.00
<br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ L Q� . �JV
<br /> " CONTRACT PRICE or JOB COST me�ns the actual or estlmated dolla� amount charged for the
<br /> permltted work Inciuding mate�ials, I�bar, profd, and other fixed costs. It is the amount to be charged to
<br /> the customer for the work done, If any material, equipment, labor or installations are fumlahed by the
<br /> owner, tenani or any other party, the reasonable m�rket value of such items must be added to the
<br /> estimated cost or contract price for permit fee purposes. In the event that there is a dispute on the
<br /> amount of the �ob cost, the Clty may request the submission of a signed copy of the actual contract.
<br /> j4j�.t•yv,� i•1•.���'� r�d��'tt���Z� '"11!4' Yrj' 1 f �, '�'�•'���1'�ql�� �� 1�'�I•`.Iry� '• �'),';
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<br /> .� u.,r �,;:,r",•'��;'�' .,�; :�w.••.�•.�
<br /> The underslgned hereby applies to the City fo�issuance of a Plumbing Permit, s�grees to do all work In
<br /> strict accordance with the ordinances of the City and the regulatlons of the State of Mlnnesota, and
<br /> certi�ies that alf statements made on this appllcatlon are complete, true and correct,
<br /> � ` � t 1�/r�-
<br /> Applioant's Signature: Date:
<br /> Building O�cial/Inspector: Date:
<br /> Page 2
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